Terrence Shaneyfelt

Fall 2017
EDTECH 592
Reflection/Research Paper

Becoming an Educational Technologist Physician: My Journey of EdTech

Learning

Introduction

I often get asked what is your degree in? Why are you getting that? I am a 51-
year-old Professor of Medicine and I decided to go back to school a couple of years
ago, not for my job, but for me. It seems I like collecting degrees. I have BS, MD, and
MPH degrees. Those degrees all made sense as I was on a path to becoming an
academic physician. The MET degree surprises people because I really dont need it for
my job. I want it for my job.
Several years ago I taught a face-to-face course in evidence-based medicine-
how to critically read and apply the results of research to patient care. It combines
epidemiology, statistics, and clinical reasoning. The medical school decided it was time
to change the curriculum to a more systems-based approach and I was informed my
course would now be offered online. My naive view was that over a couple of days I
would just take all my PowerPoints and put them online and I would be done. I learned
very quickly that isnt how it's done. I was assigned a science educator as a mentor and
this path began.
The first thing I was told by him was that I would be a constructivist (whatever
that was) and I needed to design my course using backwards design (whatever that
was). So, I started a journey to figure this all out. I discovered this whole word of tools
that could facilitate learning. Who knew there was more than PowerPoint and Prezi? I
began to download apps and software. I began reading about teaching technologies. I
bought a book on adult learning (Merriam and Bierema, 2014). It got out of control.
I incorporated all my new knowledge and tools into my lectures to med students
and residents. I thought they would be amazed and love all my new gadgets and toys.
They didnt. I had failed. Then I realized I had no clue of how to decide if a tool was
good and when it should even be used. I realized I needed formal training in educational
technology if I was going to be an effective teacher. After researching several programs,
I decided to enroll at Boise State University and begin my journey.
Lesson One: Reflections on Learning

How do people learn? This is an incredibly complex question that I don't think
has a definite answer. Theories abound but my naive view of the answer is it depends.
It depends on what needs to be learned. It depends on if the learner is an adult or child.
It depends if the learner is alone or learning with others.
During EdTech 503 and 504 I really delved into learning theories. I came away
from 503 thinking an educator had to subscribe to one of the major learning theories (as
this is what I was told by a mentor at my home institution). A major revelation I had
during EdTech 504 was that I didnt have to be any one thing. I didnt have to be a
behaviorist or a constructivist or a connectivist. I was whatever the learning task called
for. I teach medical students and residents. I teach them procedures and information on
all levels of Blooms Taxonomy. When I teach them how to perform a domain-specific
skill, for example a joint injection, I am a behaviorist because I am trying to change the
form of an observable behavior (Larson and Lockee, 2014, p. 80). When I facilitate a
jigsaw activity in an online course on evidence-based medicine (EBM) I am a
connectivist as I help learners leverage technology to make connections to information
sources and people (Larson and Lockee, 2014, p. 80). When I teach in the clinical
setting I am a constructivist as I help learners solve real-world problems building on
prior knowledge (Larson and Lockee, 2014, p. 80). No one learning theory can explain
how learning occurs in all settings. They each explain certain aspects of learning.
Adults learn differently than children. Adult learners are self-directed, utilize their
experience for future learning, demonstrate a readiness to learn, prefer to solve
problems, are internally motivated, and need to know why they need to learn something
(Merriam and Bierema, 2014, p. 47). Once I learned about andragogy I became more
cognizant of designing learning activities centered around these principles. I developed
more authentic clinical scenarios to shape learning a topic (adults want to solve
problems). I give learners choices about which medium (pdf, slides, links to online
resources, video) they want to use to facilitate learning a topic (adults are self-directed)
in my online EBM course. In the clinical setting I help them discover how a new topic
relates to their previous experience (adults rely on experience). Much of the clinical
teaching I do is not graded and doesnt need to be because the residents are internally
motivated to provide good care to patients. Finally, I relate to them (if its not obvious)
why something I am teaching them is important either clinically or because it will be on
their certifying examination (adults need to know why they need to learn something).
I think we learn differently when we are alone vs. learning in a social setting. I do
think some things just have to be learned on your own like background material. I cant
imagine learning some of the biochemical pathways and anatomy I had to learn in
medical school with others. I do think, though, much of learning is best done socially. I
think we learn best when we negotiate meaning with others. The sharing that occurs
can really shape our understanding of a topic. We each have unique experiences that,
when shared, help with constructing meaning. To this end, I incorporate group learning
activities into my courses whether it be a threaded discussion or a group project.
Id be remiss if I didnt mention Mayers cognitive theory of multimedia learning
(2014). This theory has shaped a lot of my instructional design. Much of what we use to
teach contains both words and pictures. Mayers work on how we sense and process a
multimedia message is seminal. When I design multimedia messages I try to minimize
extraneous processing, for example by placing text near a corresponding graphic- the
spatial contiguity principle, while maximizing generative processing.
Finally, I developed this graphic to summarize my thoughts on how we learn.
Data is useless unless some intelligence is added to it to convert it to information. For
example, 96, 89, and 92 are numbers that dont tell you much. If I add that they are
temperatures (intelligence added) then they become information. Information must be
contextualized and internalized to become knowledge. Finally, once we understand the
nuances, implications and values of knowledge we can develop meaning of that
knowledge. This step is learning and involves both the cognitive and affective domains.

Lesson Two: The Art & Science of Teaching

Prior to the MET program I had no formal education training. I am an academic

physician and physicians are assumed to have innate teaching skills; an errant
assumption. While I have learned a lot about the art and science of teaching, I will limit
my thoughts to the few aspects I think are most important for me.
My approach to teaching has changed significantly in several ways since
beginning the MET program. The first change that I made was to no longer view my job
as teaching but instead as facilitating learning. I teach adults (medical residents) who
are motivated and self-directed learners. They know what they want to learn and why
(Merriam, 2001). I view my job as developing or facilitating learning experiences to help
them succeed in their learning needs.
Prior to the MET program I chose technologies to use for teaching based on their
coolness factor and not based on their ability to facilitate learning. I used tools with no
explicit goal other than to try something new. I had no understanding of how to select a
technology and to assess its effectiveness. The second important change that I made is
to develop a framework to match the technology to the learning goal (Canole, Dyke,
Oliver, & Seale, 2004).
I was in elementary school, high school and college in the 1970s and 1980s.
Learning was viewed as an individual activity. Each student worked on the material on
their own. Interacting with other students was discouraged and viewed as a conduct
problem. Discovering the social nature of learning was a transformational moment of the
MET program. Whether it was via threaded discussions or through the many activities of
EdTech 543, I came to see the role of social interaction in making meaning out of
knowledge (Hill, 2012). We maximize learning with and from each other. For knowledge
to be socially constructed there must be sharing of ideas and resources. As such, I have
incorporated threaded discussion and social media tools into an advanced evidence-
based medicine elective that I teach.
Another transformative moment in the MET program was when I took EdTech
597: Introduction to Openness. Openness is variably defined but its 2 primary
components are transparency (visibility and accessibility to all parts of something) and
freedom (ability to do what you want to with something free of legal or technical barriers)
(Weller, 2015, p. 42). Prior to this course I had a very naive view of openness. My only
exposure to openness was via open access medical journals which are looked down
upon by the academic establishment as being less rigorous. I emerged from this course
changed in how I will approach my teaching and publishing in the future. As I noted
above, there must be sharing of ideas and resources to socially construct knowledge.
To share fully, things must be open. What will I do differently in the future? I will strive to
published more of my PowerPoint slides to SlideShare for anyone to use and make my
teaching videos public on YouTube. What I havent done in the past (and I will in the
future) is to make sure I put a Creative Commons license on my materials that clearly
allows for open use with attribution. I will also strive to make publications open access
(when I cant publish in an open access journal) and to publish more in open access
journals when possible. I will also encourage learners to publish materials they create in
an open way.

Lesson Three: The Design and Evaluation of Instruction

Prior to the MET program I designed one course using backward design
principles but had no idea of other instructional design models or the process of
instructional design. There are many things that I have learned about the design and
evaluation of learning during the MET program. The most important related to
instructional design are that I learned about the various analysis components, how to
develop good learning objectives, and how to design and implement proper assessment
of learning outcomes.
In EdTech 503 I learned about the ADDIE model (analysis, design, develop,
implement, evaluate), an iterative approach to instructional design (Allen, 2006). I didn't
realize how important the first step, analysis, is. As noted by Larson and Locke (2014,
p.23), the analysis is broad and includes identifying stakeholders and their expectations,
defining the problem and analyzing needs, assessing resources and constraints,
analyzing learner needs, analyzing contexts, and analyzing content. Prior to 503, when I
designed an educational activity I undertook none of the steps formally. At most I would
judge what the learners needed, and developed instruction based on my assumptions.
Doing a formal analysis as part of the 503 course project was eye opening. The product
I ultimately developed was much different than I would have developed had I not
undertaking the analysis steps.
Prior to EdTech 503 I could develop basic learning objectives. I had knowledge
of Blooms Taxonomy and usually incorporated activities at varying levels based on the
learners baseline knowledge. What I didnt do is design SMART learning objectives
written from the learners point of view that aligned the outcomes, assessments, and
teaching strategies. SMART objectives are specific, measurable, action oriented,
realistic and timely (Larson and Locke, 2014, p. 118). I now make sure all objectives are
SMART and contain the audience, behavior, conditions, and degree (ABCD)
components. As an example, here is the course objective for an arthrocentesis course I
developed for Internal Medicine residents (note ABCD added for demonstrative
purposes and are not included in the actual objective): Given a patient with joint
complaints for which arthrocentesis is indicated (C), internal medicine residents (A) will
correctly(D) perform arthrocentesis (B). The outcome, correctly performed
arthrocentesis, is specific, measurable (I developed a validated rubric to do so), action
oriented and realistic as residents must competently perform this procedure before
completing training.
Finally, I follow Kirkpatricks four-level model of evaluating learning outcomes
(Bates, 2004). I think of this model as follows: if learners liked the instruction and it met
their needs (level 1) they should learn something (level 2). If they learn something it
should change their behavior or performance (level 3) which should then improve
outcomes (level 4). Previously I had only assessed level 1 outcomes as our
departmental lecture rating tool assesses attendee satisfaction. Now I assess at least
the first three levels. In the arthrocentesis course I assess resident knowledge with self-
assessment tests (level 2) and their performance of arthrocentesis on a cadaver (level
3). I informally assess outcomes when I observe them perform unassisted
arthrocenteses on real patients in the clinical setting (level 4).

Lesson Four: Networking and Collaboration

Prior to the MET program I did not like to collaborate with colleagues on projects,
other than research grants and publications, for a couple of reasons. I am very OCD
about how things are done, and it was hard to get collaborators to adhere to my way of
doing things (and Im sure they had similar feelings). I also procrastinate somewhat until
a deadline approaches and then I tend to do my best work. That is a risky approach
when collaborating with others, especially if they procrastinate too.
Prior to the MET program I had begun to develop a personal learning network
(PLN) of thought leaders in my academic field of interest and thought leaders in
educational technology. My PLN became a valuable source for articles and resources
that I would not have found on my own. I further cultivated, expanded, and better
understood my PLN during EdTech 543 when we explored the concept of a personal
learning environment (PLE). A PLE includes your PLN and the tools you use to interact
with it. I created a diagram to portray my PLE to convey the devices, services, and
various tools I use to interact with people and information. People includes colleagues,
friends, communities of practice I belong to, communities of inquiry, and other smart
people around the world. I follow the 4 Cs model created by Chris Sessums to
design/understand my PLE (Malamed, 2017). The 4 Cs are collect, communicate,
create, and collaborate. As such, there are 3 zones to the devices, services and tools
layer of my PLE diagram. At the bottom, are tools I use to create and communicate. On
the right, are tools and ways I like to learn, including using online, print, and verbal
media. Finally, on the left, are the tools I use to collect, communicate, and collaborate.
All these tools are also used by others to interact with me.
I also explored the research base of PLNs. I was introduced to connectivism in
EdTech 503 but learned more deeply about it in both EdTech 543 and 597. For me,
connectivism (along with social constructivism) underlies the whole concept of
networking and collaboration. Connectivism is a framework to understand learning (Kop,
2008). A node is a source of information or resources in a larger network of nodes.
Connectivism posits that knowledge is distributed across a network of connections, and
therefore that learning consists of the ability to construct and traverse those networks
(Downes, 2007). This contrasts with other learning theories which view knowledge as
something that can be possessed. But even if you view knowledge as being possessed,
it is via chemical transmissions between neurons (which can be thought of as nodes) in
the brain (a massive network) that we store or possess knowledge. So really
connectivism shouldnt be as controversial a topic that it is (Kop, 2008).
It all came together (from the standpoint of my professional life and my MET life)
when I had an epiphany about the practice of medicine and connectivism. As doctors
we can't know everything. Medicine is just too expansive and specialized. We get
consults on patients who are outside of our expertise. We contact a node (the
consultant) in our network. I had never made that connection before (pardon the pun).
And if that was the case that I used connectivism in daily practice, then why not use
connectivism in daily teaching. I redesigned an elective I teach in advanced EBM to
include more connectivist principles. Students had to develop and cultivate a PLN and
use it for the course. In their course reflections they saw the value of the network. Just
as I had, they understood that knowledge can reside outside of us and can be
interacted with to learn.
Lesson Five: The Research-Practice Connection

The research-practice connection has been central in my career. My area of

academic interest is evidence-based medicine (EBM). There are variable definitions of
EBM, but I usually explain it as the critical application of research evidence to patient
care. The critical application part is complex and multifaceted. It involves critically
analyzing your knowledge deficit in a clinical area and deciding if you have the time and
resources to fix your knowledge deficit. It involves critically appraising a research paper
for its scientific validity. Finally, it involves critically analyzing the clinical situation to
know if how the evidence applies to the patient. I describe it as knowing what you
should do, not just what you could do.
This paradigm applies to and parallels educational technology also. In EdTech
501, I learned about the definition of educational technology as proposed by the
Association for Educational Communications and Technology. They define educational
technology as the study and ethical practice of facilitating learning and improving
performance by creating, using, and managing appropriate technological processes and
resources (Januszewski & Molenda, 2008, p. 1). Study encompasses research and
reflective practice (Januszewski & Molenda, 2008, p. 1). The research base in medical
education is way behind that of K-12 or higher education. Educational technology in
medical education largely focuses on simulation. Reflective practice considers the
problems in their environments and attempts to resolve the problems by changes in
practice, based upon both research results and professional experience (Januszewski
& Molenda, 2008, p. 2). This is very similar to EBM. Most clinicians are reflective. In
EBM we consider the patients situation (their environment) and use our professional
experience to decide what to do.
I really began to apply more sound research principles to education when I took
EdTech 513, 522, and 523. While many of my other courses were clearly founded on
research they were not as explicit in using research-based principles as those three
courses. Mayers work has greatly impacted my instructional design (Mayer, 2014). I
reflect on and incorporate his multimedia principles into my multimedia educational
materials. Since I teach online a lot I have utilized all the best practices I learned in 522
and 523 in developing and revising my online courses. As part of my promotion
package, Dr. Kerry Rice reviewed an online course I teach and felt it incorporated
research-based best practices.

Closing Thoughts

In the introduction to this paper I reflected that prior to beginning the MET
program I had no clue of what, when, and how to use educational technologies in my
teaching and professional life. That has all changed now. I have learned a lot and have
advanced professionally through both my coursework and professional practice. With
each course I increased my knowledge of educational technology, learning theories,
instructional design, and research practice. I have demonstrated my learning through
creating online media, instructional materials, and online courses.
I know I am an effective teacher. I know the theoretical foundations of what I am
doing and can apply them. Though many would say their journey is complete with
graduation and earning their MET, I know mine is still ongoing. I still feel I have miles to
go on this journey.
My biggest concern is that I will no longer have a guide to help me. My teachers
and classmates kept me on the path for learning this material. They occasionally
pushed me off so that I could explore some other area, but they always helped me find
my way back. While I have created a PLN, which includes some of my classmates, their
fields of interest and jobs are so vastly different than mine that I dont feel they can still
be my guide. I already miss that sense of excitement, discovery, and accomplishment I
felt during each course. I guess that is part of phasing out one part of life for another. I
know I will always be grateful to BSU Educational Technology for being a major stop on
my journey. I wish I could have sat a spell longer.

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